486803808-3-13-2024-21-AS-KMOA-D3KNMF-20240321103501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803808
Report Date: 03/11/2024
Date Signed: 03/13/2024 10:18:07 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2023 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20231206104607

FACILITY NAME:	COGIR OF VALLEJO HILLS		FACILITY NUMBER:	486803808
ADMINISTRATOR:	CLAREY, KAITLYN		FACILITY TYPE:	740
ADDRESS:	350 LOCUST DRIVE		TELEPHONE:	(707) 266-6822
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	80	CENSUS: 41	DATE:	03/11/2024
		UNANNOUNCED	TIME BEGAN:	01:27 PM
MET WITH:	Susan Allen, Executive Director and Saveiro Gratteri, Executive Chef		TIME COMPLETED:	05:13 PM

ALLEGATION(S):

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Facility's signal system is not working properly.
Facility staff did not answer residents' calls in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Araceli Canela arrived unannounced, for the purpose of gathering additional information and delivering findings, regarding the above listed allegations. LPA met with Executive Director, Susan Allen, gathered additional statements and received copies of records. LPA also met with Saveiro Gratteri, Executive Chef who was authorized to sign reports at the end of the visit.

It was alleged facility's signal system is not working properly. Investigation revealed there had been an issue with the front door phone not working properly after hours, when the main entrance door is locked and residents and/or family members who need to use the phone call system to alert staff to open the front door, or need assistance, has not been working. Residents have had to wait long periods of time. On a previous visit of 1/4/2024, Administrator explained they were working on the issue and purchased new phones and they were waiting to be installed. On todays visit, Administrator stated the front door system has been installed and new phones are operational, calls get directed to a cell phone that a staff member carries and there has been no further issues.
Continue report see LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20231206104607

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: COGIR OF VALLEJO HILLS	FACILITY NUMBER: 486803808
	VISIT DATE: 03/11/2024

NARRATIVE

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Continue report from LIC9099
In addition it was reported the call button pendant system was not working properly as staff were not always responding timely because the system at times would not go to the staff to respond. It was corroborated staff were not alerted when R1 pressed their pendant call button for assistance. Records show the call button was activated, but staff did not hear it.

It was also alleged facility staff did not answer residents' calls in a timely manner in that when residents activate their call buttons during noc shift, a signal is sent to the front desk, however, the front desk was no longer staffed during the noc shift so no one heard it. It was also reported the noc shift staff wear pagers, however the residents’ calls do not go from the front desk to the pagers.
It was corroborated resident R1 used their call button as they needed their PRN medication, staff were not responding and R1 had to leave their room to locate staff. Records show it has taken staff up to 32 minutes to respond to a residents call for assistance. Administrator expressed Issues with the residents pendant calls have also been corrected and staff are alerted when a resident requires assistance and push their call button as the phones are working properly.

Based on the information received and records gathered, both allegations for, Facility's signal system is not working properly and Facility staff did not answer residents' calls in a timely manner are found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20231206104607

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: COGIR OF VALLEJO HILLS	FACILITY NUMBER: 486803808
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/12/2024 Section Cited HSC 1569.269(a)(6)	1 2 3 4 5 6 7	1569.269(a)(6)Enumerated rights; severability(a)Residents of residential care facilities for the elderly shall have all of the following rights: (6)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Facility to send in written statement on action taken and how facility will stay in compliance. POC due date for written statement due 3/14/2024. Facility to provide in-service training to staff regarding regulation and reporting when there is an issue with the call system.
	8 9 10 11 12 13 14	Based on Investigation and records reviewed, the licensee did not comply with the section cited above by not ensuring that residents call buttons were working properly and reaching staff when they required assistance. R1 waited about 32 minutes & then left their room to search for staff to provide them with needed medication. This is an immediate risk to the health & safety of residents in care.	8 9 10 11 12 13 14	Proof of training due 3/21/2024 attention LPA A Canela
Type B 04/05/2024 Section Cited CCR 87303(i)(1)(B)	1 2 3 4 5 6 7	87303(i)(1)(B)Maintenance and Operation (i)Facilities shall have signal systems which shall meet the following criteria: (1)All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Facility purchased and installed a new phone system. Facility to submit a written plan on how it is being used and how facility will stay in compliance. Facility to conduct in-service training and provide plan on how the call system, pendant calls will be monitored to ensure they are working properly.
	8 9 10 11 12 13 14	Based on statements received, it was corroborated that there was an issue with the phones not working properly and staff were not properly alerted when they needed to open the front door after hours and pendant calls were not always transmitting a signal to staff. This is a potential risk to the health and safety of residents in care.	8 9 10 11 12 13 14	Plan of Correction due 4/5/2024 attention LPA A Canela.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

LIC9099 (FAS) - (06/04)

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